巨大的钙化型胸椎间盘突出症的后路椎管减压治疗  

Spinal canal decompression of giant calcified herniated thoracic discs

作　　者：伦登兴[1,2] 徐兆万[1,2] 钟军[1] 庄青山[1] 刘大勇[1] 厉峰[1] 隋国侠[1] 

机构地区：[1]潍坊市人民医院脊柱外科,261042 [2]潍坊市骨科修复工程技术研究中屯

出　　处：《中华骨科杂志》2015年第12期1184-1190,共7页Chinese Journal of Orthopaedics

基　　金：山东省科技发展计划（2013GSF11869）

摘　　要：目的探讨经后路治疗巨大的钙化型胸椎间盘突出症的临床疗效。方法2005年1月至2012年6月共经后路手术治疗巨大的钙化型胸椎间盘突出症患者17例，男11例，女6例；年龄21-81岁，平均55．7岁。其中旁中央型7例，中央型10例。椎管内占位面积52％-90％，平均71．7％±9．6％。Frankel脊髓功能分级：A级1例、B级6例、C级6例、D级4例。术中切除棘突、椎板及关节突，经双侧关节突人路，采用自制角翼骨刀切除腹侧钙化型椎间盘。术后评估疼痛视觉模拟评分（visualanaloguescore，VAS）、Et本骨科学会（JapaneseOrthopaedicAssociation，JOA）胸椎评分、Frankel脊髓功能分级及并发症发生情况。结果所有患者均获得随访，随访时间18--60个月，平均（37±12）个月。手术时间70-180min，平均（120±63）min；出血量461±1500ml，平均（471±198）ml。末次随访时疼痛VAS评分为（1．12±0．07）分，较术前（8．01±0．21）分明显降低。术后JOA胸椎评分持续增加，术前、术后1周、术后3个月及术后12个月的差异均有统计学意义；其中术前、术后12个月JOA胸椎评分分别为（3．17±．83）分和（8．78±0．94）分，改善率为65．1％±23．4％，12个月后JOA胸椎评分基本稳定。末次随访时Frankel脊髓功能改善1或2级者16例，无改善1例。1例术后症状加重，1例出现伤口感染，1例出现脑脊液漏。结论经后路椎管减压治疗巨大的钙化型胸椎间盘突出症手术时间短、出血量少、并发症发生率低，是一种安全、有效、可行的治疗胸椎间盘突出症的方法。Objective To assess the study outcomes in a consecutive series of patients with thoracic disc herniation （TDH） who undergone posterior spinal canal decompression and discectomy with segmental instrumentation and fusion. Meth- ods Between January 2005 and June 2012, the data of 17 patients （11 males and 6 females） was retrospectively reviewed and analyzed. Disc herniation was classified as central in 10 eases and paracentral in 7 eases. The average canal encroach- merit was 71.7%±9.6% （range, 52% to 90%）. Their mean age at surgery was 55.7 years （range, 21 to 81 years）. All patients un- derwent a transfacet decompression and segmental instrumentation with interbody fusion. The data of patients included clinical presentation, blood loss, operative time, complications, visual analogue scale （VAS）, Japanese Orthopaedic Association （JOA） score, and Frankel grading system. Results The average follow-up period was 37±12 months. The average surgical time was 120±63 min. The mean blood loss was 471±198 ml. Mean preoperative VAS score was 8.01±0.21, which improved to a mean of 1.12±0.07 at final follow-up. Average pre- and post-operative at 12 months JOA scores were 3.17±0.83 and 8.78±0.94 points, respectively. The average recovery rate was 65.1%±23.4%. Overall JOA scores showed a significant postoperative im- provement. All patients reported 1 or 2 grade improvement ira Frankel grading compared with preoperative status except for 1 patient whose grade had not changed. There were three complications, including one patient developing postoperative wound in- fection, one experiencing a cerebrospinal fluid leakage, one developing further neurological deterioration. Conclusion The re- suits suggested that the posterior approach using special shaped osteotomy is feasible for central calcified TDH. No major com- plications occurred for achieving adequate decompression for central calcified TDH.

关 键 词：胸椎 椎间盘移位 椎关节突关节 椎板切除术 

分 类 号：R687.3[医药卫生—骨科学]